A Long-term Care Perspective
Any consideration of demographic change and the Canadian health system will inevitably point to our aging population. It is generally held that baby boomers (born between 1947 and 1966) will have a dramatic impact on the Canadian health system in the next five decades.
When the public system began to focus its resources on building hospital capacity in the 1950s, there were many young people and relatively few older people, and just 7% of our population was seniors. Today, that figure is close to 14% and by 2035 seniors could amount to 24% of the total population. Currently 93% of Canadian seniors live in private dwellings and it is expected that in future decades most seniors will continue to live in relative independence, perhaps with the help of caregivers.The rate of institutionalization of seniors has decreased since the early 1980s. The most marked decline occurred among persons 85 years and older, which, by the way, is the fastest growing cohort in our society.
But as we celebrate the fact that Canadian demographic trends reflect a senior population that is more fit and has greater longevity than at any other time in history, we must be mindful that significant numbers of our most frail and chronically ill citizens will need to live in long-term care residences. Community support services, home care and supportive/assisted living arrangements will not be able to provide the necessary services for some individuals. Elderly Canadians with complex disability and functional deficits as a result of injury or progressive neurological degeneration (MS, dementia) will require the services that long-term care homes can best provide.How do we ensure that the long-term care sector is ready, willing and able to provide quality and respectful care for the most vulnerable citizens of our society? By investing in its talent.
Long-term care has an eclectic workforce made up of nurses, personal support workers, managers, administrators, physicians, dietary aides and other service employees. Their education levels, backgrounds and personal experiences vary, but each person provides an essential service. The work is fast-paced, demanding and, at times, wearisome. It is an accepted maxim that there is no fluff in this sector.Long-term care is human-resource intensive, with approximately 80% of operating budgets allocated to salaries and benefits. Adequate staffing as expressed in numbers, mix, knowledge and engagement is the key to delivering quality care in long-term settings. As more technology is introduced, this will add to the required competencies of staff. In addition, the College of Nurses of Ontario has recognized that, “Compared to even 10 years ago, the complexity of residents has increased – G tube feeds, catheters, oxygen… pain control and palliative care are added dimensions to an increasing and more incapacitated population.”
This vital segment of the health care continuum requires sufficient professional and support staff to provide excellent care and service, the proper talent mix, good staff morale, continuing education and an overall plan for an adequate supply of talent to meet future demand. But engagement is the key.Numerous reports attest to the high-quality service provided by engaged staff in long-term care homes. The report of the House of Commons Standing Committee on National Defence and Veterans Affairs (2003) succinctly stated, “The most common trait that we found amid all the variations in terms of problems and resource levels was the dedication of the staff and their desire to provide the best possible care.” Yet it is becoming increasingly difficult to recruit talent – and retain it.
Successful long-term care workplaces empower their staff. One key method for keeping professional staff such as nurse practitioners, registered nurses, registered practical nurses and therapists engaged is to enable them to work to their full scope of practice. Progressive employers do not just displace one health care professional with another, but rather recognize the unique skills each player brings to the team and facilitate everyone’s functioning within an interdisciplinary team environment. Some employers identify and develop internal talent and therefore build upon the knowledge and skills of their employees, mentoring them to higher positions within the organization.Despite enlightened human resource practices, staff in long-term care homes face major challenges every day. According to the 2005 National Survey of the Work and Health of Nurses, 50% of nurses working in long-term care homes reported having been physically assaulted by a resident during the previous year and 48% reported emotional abuse from a resident. The results are similar among unregulated front-line staff such as personal support workers and housekeeping aides, who spend much of their time in close proximity with residents.
A study by York University researchers resulted in a disturbing comparison between the long-term care work environments in Canada and Scandinavia. Workers at 71 unionized long-term care homes in Manitoba, Ontario and Nova Scotia were surveyed about their experiences of physical violence, unwanted sexual attention and racial comments. The study found that 43% of front-line care aides in Canada endured daily physical violence in the workplace, while another quarter had to contend with aggression every week. They were nearly seven times more likely to experience such daily violence than workers in Denmark, Norway, Finland and Sweden. Many long-term care staff members gain intrinsic satisfaction from their work. They particularly enjoy engaging in the affective dimensions of care, such as listening and reminiscing with residents. But these same health care workers feel that those who work in other health care settings do not regard long-term care as a legitimate specialty. Nurses, for example, have felt that their skills, expertise and services are not as valued as those of nurses in acute care.
A May 2007 report by the College of Nurses of Ontario, Supporting Quality Nursing Care in the Long-Term Care Sector, contained a statement by a long-term care nurse that there is “a strong sense of long-term care being a second-class sector managed by second-rate nurses…”All categories of long-term care staff are experiencing high turnover rates, resulting largely from unsustainable workloads, physical and mental exhaustion, and poor morale. In 2007 the Quality Worklife–Quality Healthcare Collaborative deemed the turnover rate one of seven critical indicators in the management of healthy health care workplaces.Yet many employees enjoy working in long-term care and remain there throughout their careers. Some consider a career in this field a “calling.” They feel thoroughly engaged, express satisfaction with their vocation and speak warmly of the residents entrusted to their care. Long-term care staff discover that they possess a remarkable capacity to learn, to teach, and to positively impact care when they connect with residents and each other.
Despite what may be assumed by those unfamiliar with long-term care, a unique body of knowledge and skill is required to master the many challenges encountered in the work. Staff who thrive, rather than simply survive, have common characteristics: empathy, patience and a desire to learn and make a difference in the lives of others. Care of the confused and infirm is neither undesirable nor demeaning, although difficult conditions often detract from the integrity of the work.Working in long-term care can be professionally exhilarating. But for each person who experiences such fulfillment, there is likely another who becomes dispirited, disconnected, and considers leaving the field. This is a sobering thought in the retention and recruitment arena. Harnessing their talent is critical because they are the caretakers of people’s lives – and we can’t lose sight of that.
Employee engagement is not simply desirable, it is essential. It cannot be done off the side of your desk or by assigning one person to “run with it.” Unfortunately, in long-term care we sometimes sacrifice the important in the interests of the urgent. And there are always matters that seem urgent. But are they important? Is there anything in your organization today that is more important than the engagement of your talent?We often say that people are our most valuable asset. Investing in our talent through engagement is a journey, not a six-month project. It begins with an organization, its leadership and stakeholders taking time to reflect. A good place to start is with the following 21st century credo in long-term care:
Tell me and I will forget
Show me and I will remember
Involve me and I will understand